A technique of tongue fixation after total mandibulectomy: the Oji spatula

When ameloblastoma presents late, as is often the case in Nigeria, it can affect the whole mandible. The treatment of choice is total mandibulectomy. The procedure may necessitate the resection of the musculature of the floor of the mouth to which a large portion of the tongue is attached. In our hospitals, immediate reconstruction is not undertaken for various reasons. Consequently, the musculature of the floor of the mouth cannot be reattached to a graft. The purpose of this paper is to illustrate a simple and patient-friendly method for fixation of the tongue after total mandibulectomy to achieve a secure airway. The tongue is tied to a wooden spatula, which stretches horizontally across the mouth. It is in contrast to the conventional technique of rigid fixation of the tongue to the pectoral muscle. This technique was used for 11 patients with large ameloblastomas. For the purpose of comparison, the conventional technique was used in 4 patients. The method of using a wooden spatula as a means of tongue fixation is known in the maxillofacial unit of the University of Nigeria Teaching Hospital, Enugu as the Oji spatula after the surgeon who developed it. All 11 patients tolerated this method well, but the 4 patients who had their tongues tied to the pectoral muscle complained of pain and discomfort. All the patients survived the procedure without postoperative blockage of the airway by the tongue. Follow-up for up to 6 months established that the patients had no respiratory problems.